15 - Intrapartum and neonatal death

Summary

Introduction

Neonatal deaths may occur as complications of labor (intrapartum asphyxia and/or trauma), neonatal infections (congenital or acquired after birth), complications of prematurity, lethal congenital abnormalities, metabolic diseases, etc. In this chapter we will focus on intrapartum asphyxia and trauma and neonatal infections. For other conditions, refer to the appropriate chapters.

Intrapartum death is the death of an infant once labor has started. This includes a stillborn infant whose death occurs while the mother is undergoing monitoring in labor [1–3]. Generally this is a fresh stillborn infant with no evidence of maceration [4], indicating death within 12 hours of delivery. Intrapartum deaths are rare in Western societies, reflecting the quality and availability of intrapartum care [1,4–6] and are considered potentially preventable [5]. The global annual number is estimated to be in the region of one million [7], although the rate of intrapartum death varies according to the socioeconomic status of the country; in Westernized societies the rate is much lower than poorer countries. In high-income countries, the proportion of intrapartum stillbirths to all stillbirths is under 10%; in low- and middle-income countries it may be as high as one-third [3]. The rates are likely to be affected by confounding factors – for example, if a mother undergoes a long labor exceeding 12 hours with fetal demise early in this labor, the stillborn infant will show signs of maceration and the death may not be included in the intrapartum death category [7].